Surgical tube



6, 1968 L. F. PLZAK. JR 3,395,711

SURGICAL TUBE Filed May 26, 1965 INVENTOR LOUIS F. PLZAK JR ATTORNEYUnited States Patent 3,395,711 SURGICAL TUBE Louis F. Plzak, Jr., 1 GlenBrook Road, Wellesley, Mass. 02181 Filed May 26, 1965, Ser. No. 458,856Claims. (Cl. 128-351) ABSTRACT OF THE DISCLOSURE A relatively soft andflexible surgical tube having a flange portion, an adapter forconnection to respiratory equipment and a wire obdurator removablyreceived in the tube to assist in introducing the relatively soft andflexible tube into the trachea.

This invention relates generally to surgical tubing and moreparticularly to tracheostomy and endotracheal tubes.

The invention has for an object to provide a novel and improved surgicaltube characterized by being composed of a soft, flexible non-rigidmaterial capable of conforming readily to the shape of the patientstracheal contour and to contour changes due to different postures of thepatient.

Another object of the present invention is to provide a novel andimproved surgical tube of the character specified which is furthercharacterized by novel means for facilitating insertion of therelatively soft flexible tube.

The invention has for another object to provide a novel and improvedsurgical tube of the character specified which is further characterizedby being composed of a biologically inert material whereby to reduce toa minimum stimulation of mucous secretions effected by the tube.

Another object of the invention is to provide a novel and improvedsurgical tube, such as a tracheostomy tube or an endotracheal tube, ofthe character specified having an adapter at its proximal endparticularly adapted for connection to conventional respiratoryassistance equipment.

A still further object of the invention is to provide a novel andimproved surgical tube, such as a tracheostomy tube, having a flange atits proximal end adapted for superior fitting to the neck of thepatient.

With these general objects in view and such others as may hereinafterappear, the invention consists in the surgical tube as hereinafterdescribed and particularly defined in the claims at the end of thisspecification.

In the drawings illustrating the preferred embodiment of the invention:

FIG. 1 is a front elevation in cross section of a tracheostomy tubeembodying the present invention;

FIG. 2 is a cross sectional view of the same in side elevation;

FIG. 3 is a plan view of the tracheostomy tube shown in FIG. 2;

FIG. 4 is a view similar to FIG. 3 showing a modified form of thepresent tube;

FIG. 5 is a side elevation of a modified form of the present tubeadapted for use as an endotracheal tube; and

FIG. 6 is a side elevation of a further modified form of the presentinvention.

In general, the present invention relates to a novel surgical tube, suchas a tracheostomy tube or an endotracheal tube. The invention is hereinillustrated as embodied in a tracheostomy tube for use when it isnecessary to provide an artificial airway into the trachea through asurgically created opening in the anterior aspect of the trachea. Thisnecessity may arise in conditions of respiratory insufficiency in whichit is desirable to decrease the amount of respiratory dead space; tobetter control and assist the respiratory effort of the patient; topermit tracheal-bron- 3,395,711 Patented Aug. 6, 1968 chial cleansing;and to by-pass areas of upper airway obstruction.

The prior tracheostomy tubes now in use consist of rigid matched innerand outer tubes with a flange on either side of the outer tube to whicha tape or strap is attached and then tied around the neck. These rigidtubes are constructed of relatively reactive materials, such as silveror rigid plastic material of predetermined and set curvature. Thereactive materials cause irritation of adjacent tracheal mucosa which inturn promotes increased mucous secretions tending to obstruct theairway. This necessitates the presence of an inner tube which can befrequently removed for cleansing purposes. The rigidity of such priortubes does not allow for individual variations in the contour of thetrachea or changes in the contour with changes in the patients posture.Also, such prior tube materials do not lend themselves to be readilyshortened by the physician as may be necessary to prevent a long tubefrom obstructing one or another of the mainstem bronchi, nor do theypermit the tubes to be fenestrated by the physician. The use of a doubletube results in a relatively narrow internal diameter in relationship tothe outside diameter, but the greater the relative internal diameter,the greater the safety of the tube as occlusion of the lumen by mucousis less likely.

In accordance with one feature of the present invention the presentsurgical tube comprises a non-reactive, transparent material, such as asilicone rubber, which is characterized by being biologically inert andwhich is sufliciently soft and flexible to conform to the contour of anytrachea. The inert properties of silicone rubber reduce to a minimum thepromotion of mucous secretions in the trachea so that the inner tubeformerly used to remove such secretions is eliminated entirely in thepresent tracheostomy tube. The relative softness of the silicone rubbertubing also avoids traumatic injury during insertion thereof and alsoprevents damage due to pressure against the tracheal wall by the tubewhich might otherwise occur with the prior tubes because of individualdifferences in tracheal contour or contour changes due to posturechanges. This feature is extremely important when the tube is insertedin the trachea of an infant where the trachea is delicate and readilyperforated by rigid tubes.

Prior to the present invention it has been necessary to employ a rigidor semirigid material having a set curvature in the construction of suchsurgical tubes so that the tube could be better controlled and movedinto position. For this reason, it has not been considered practical toemploy a relatively soft, flexible and limp material, such as siliconerubber, for surgical tubing. In accordance with another feature of thepresent invention, I provide a rigid obdurator or stiff wire introducerwhich may be inserted into the opening of the relatively soft, flexibletube to permit the tube to be easily inserted whereupon the introducermay be withdrawn.

In accordance with another feature of the present invention, theproximal end of the tube is provided with a cup-shaped silicone rubberadapter molded integrally with the tube and which is of a size such asto facilitate connection to existing respiratory assistance equipment.The present tracheostomy tube is also provided with a circular siliconerubber flange molded integrally therewith and to the adapter, the flangebeing reinforced with nylon mesh molded therein to prevent tearing. Theflange is also provided with openings through which a strap or tape maybe threaded for tying around the neck. The inert nature of the flangealso makes possible direct suturing of the flange through the nylon meshto the neck in the cases of infants to insure against inadvertentremoval of the tube from the trachea.

Other advantages of the present silicone rubber surgical tube are thatit is light in weight; sturdily constructed;

and capable of being sterilized by heat, gas or any of the conventionalsterilizing solutions. The present tube may also be easily cut to thedesired length by the surgeon at the time of its insertion.

Referring now to the drawings, 10 represents a tracheostomy tubeembodying my invention, the tube being composed of a biologically inertmaterial, such as silicone rubber, and which comprises a relatively softnon-rigid transparent flexible material. The tube 12 may be made of anyconvenient length and in practice may be cut off to the required lengthby the surgeon. The distal end 14 of the tube is cut at an angle, asshown, and the edges are rounded and smoothed to facilitate insertion.

As illustrated in FIG. 2, because of the limp and nonrigid nature of thesilicone rubber material, a rigid wire obdurator or introducer 16 havinga set curvature is extended into the tube to enable the tube to beeasily inserted into the trachea. The outer end 18 of the wire is loopedor otherwise bent to provide a stop to limit the extension of the wireinto the tube, and the inner end of the wire terminates within thedistal end of the tube. The inner end of the wire is also bent uponitself as indicated at 20 to prevent piercing of the tube. Afterinsertion of the tube, the wire introducer 16 may be withdrawn to enablethe tube to conform to the contour of the individual trachea.

As illustrated herein, the proximal end of the tracheostomy tube 10 isprovided with a cup-shaped adapter 22 molded integrally with the end ofthe tube. The adapter 22 is also composed of silicone rubber materialand is conveniently made with a 15-millimeter outside diameter to fitstandard respiratory assistance equipment. The inside diameter of theadapter is constructed so as to provide a smooth surface for easycleansing and so as to minimize dead space.

As herein shown, the present tube is also provided with a circularflange 24 molded integrally with the tube. The flange is also composedof silicone rubber material and is herein shown as molded integrallywith the adapter 22 and the tube. In order to reinforce the flange toprevent tearing thereof, a nylon mesh or lace material 26 is molded intothe flange as shown. The flange 24 is also provided with two or moreopenings 28 through which a tape or strap, not shown, may be threadedfor tying the tube to the neck. The inert nature vof the flange alsomakes possible direct suturing of the flange to the neck. It will beobserved that the openings 28 through which the straps may be threadedor tied are located remote from the opening in the neck, that is, thetie is made above the tube fixation into the trachea rather than inhorizontal alignment therewith so as to enable superior fitting to theneck.

It will be understood that the flange 24 and the tube 12 may vary insize. One size of flange as shown in FIG. 3 is provided with fouropenings 28, the nylon mesh 26 being molded around the holes, as shown,and also around the end of the tube 12 molded within the adapter 22. Asmaller size flange shown in FIG. 4 is provided with two openings withthe nylon mesh also molded around the openings and around the end of thetube. In practice, the tube size may be imprinted on the adapter or onthe flange as indicated at 25 in FIG. 5. It will be noted that the tube12 is molded into the bottom of the adapter 22 at a slight anglerelative to the base of the adapter of the flange to conform generallyto the angle at which the tube is introduced into the trachea throughthe neck.

From the description thus far it will be seen that the present surgicaltube and particularly a tracheostomy tube comprises an inert siliconematerial which is non-toxic and non-reactive in use whereby to reduce toa minimum mucous secretion by the trachea. It will also be seen that therelatively soft silicone material may be easily inserted by means of arigid wire introducer extended through the tube and that the tube willreadily conform to the patients trachea and to the changes in posture ofthe patient after removal of the wire introducer. In practice, a cap,not shown, may be provided for cooperation with the adapter for pluggingthe tube off when it is no longer desirable that the patient breathethrough the tube, but preferable that the patient breathe through thelarynx. At such time, breathing is facilitated by fenestration of thetube as it curves out of the trachea. Another advantageof the presentnon-reactive silicone tube is that it need not be re moved if thepatient undergoes radiation therapy as the inert nature of the tubecauses minimal scatter of X-rays and gamma rays.

As illustrated in FIG. 5, a modified form of the present invention isadapted for use as an endotracheal tube which is passed through themouth or nose into the trachea during surgical procedures performedunder general anesthesia in order to facilitate the anesthesia and makeit safer. Such a tube is frequently used as an emergency maneuver toprovide an airway in cases of acute respiratory or cardiac arrest. Asherein shown, the endotracheal tube, indicated generally at 30,comprises a structure similar to that above described except that iteliminates the circular flange, and the tube is made considerablylonger. As illus trated, the proximal end of the tube 32 is providedwith an adapter 34 molded integrally therewith, and a wire introducer 36is arranged within the tube to facilitate intubation of the relativelylimp flexible silicone tubing either orally or intranasally. It will beapparent that the endotracheal tube affords all of the advantages aboveascribed to the tracheostomy tube in that it comprises a biologicallyinert, non-toxic and non-reactive material and that it is capable ofconforming to the shape of the individual trachea.

FIG. 6 illustrates a modified form of the present surgical tube whereinthe tube 38 is provided at its proximal end with a flange 40 moldedintegrally therewith, the adapter being eliminated. The flange may beprovided with openings 42 and with the nylon mesh 44 molded within theflange and around the openings and the end of the tube to providereinforcement of the flange.

While the preferred embodiment of the invention has been hereinillustrated and described, it will be understood that the invention maybe embodied in other forms within the scope of the following claims.

Having thus described the invention, what is claimed is:

1. A surgical tube of the character described comprising a soft,flexible non-rigid tubing for insertion within the trachea, said tubingbeing capable of conforming to the contour of the patients trachea, andrigid means removably inserted within the tube to assist in introducingthe tube into the trachea, said rigid means comprising a stiff wirehaving a predetermined curvature, the inner end of said wire being bentupon itself and spaced from the distal end of the tube when fullyinserted.

2. A surgical tube of the character described, comprising a soft,flexible non-rigid tubing for insertion within the trachea, said tubingbeing capable of conforming to the contour of the patients trachea,rigid means remov-' ably inserted within the tube to assist inintroducing the tube into the trachea, said introducing means beingremovable after the tube is introduced, and a flange molded integrallywith the tube, said flange having openings therein through which strapsmay be threaded, said introducing means comprising a stiff wire having apredetermined curvature, the outer end of said wire being bent toprovide a stop engaged with the proximal end of said tube when the wireis in its fully inserted position, and the inner end of said wire beingbent back upon itself and terminating within and spaced from the distalend of said tube when in its fully inserted position.

3. A surgical tube of the character described comprising a soft,flexible non-rigid tubing for insertion within the trachea and which iscapable of conforming to the contour of the patients trachea, acup-shaped adapter molded integrally with the proximal end of the tubeadapted for connection to respiratory assistance equipment, a

flange molded integrally with the tube and removable means forintroducing the relatively soft tubing into the trachea including arigid member removably received within the tube, said rigid membercomprising a stilt wire having a predetermined curvature, the distal endof said rigid member being bent back upon itself and being spacedinwardly from the distal end of said tube when in its fully insertedposition.

4. A surgical tube of the character described comprising a soft,flexible inert silicone rubber tubing for insertion within the tracheaand capable of conforming to the contour of the patents trachea, acup-shaped adapter molded integrally with the proximal end of the tube,a flange molded integrally with the tube and with the bottom of saidadapter, said flange having openings therein through which straps may bethreaded for tying around the patients neck, and a nylon meshreinforcement molded into said flange and around said openings.

5. A surgical tube of the character described comprising a soft,flexible non-rigid tubing for insertion within the trachea and which iscapable of conforming to the contour of the patients trachea, and aflange molded integrally with the tube, said flange having openingstherein through which straps may be threaded, and a nylon meshreinforcement molded into said flange and around said openings.

References Cited UNITED STATES PATENTS 2,765,792 10/1956 Nichols 128-3512,923,299 2/1960 Blackwood 128-651 3,334,631 8/1967 Stebleton 128-351DALTON L. TRULUCK, Primary Examiner.

